Evaluating the Impact of Road Traffic Accidents on the Outcome of Traumatic Brain Injury (TBI) in African Urban Centers: A Systematic Review

Background: Traumatic brain injury (TBI) is a major contributor to morbidity and mortality in low- and middle-income countries, particularly in African urban centers where road traffic accidents (RTAs) are a leading cause. Limited access to neurosurgical care, imaging, and critical care infrastructure may exacerbate outcomes in these settings. This systematic review evaluates the burden, outcomes, and healthcare system factors associated with RTA-related TBI in African urban centers. Methods: We systematically searched PubMed and Google Scholar for studies published from January 2010 to May 2025. Observational studies, clinical audits, and hospital-based registries reporting on TBI from RTAs in African urban centers were included. The primary outcome was mortality and functional outcome (e.g., Glasgow Outcome Scale), and secondary outcomes included morbidity, hospital length of stay, and time to neurosurgical intervention. Risk of bias was assessed using the Newcastle-Ottawa Scale and QUIPS tools. Data were synthesized narratively, and no meta-analysis was conducted. Quality of evidence was graded using the GRADE approach. Results: A total of 13 studies involving 6,453 participants across 8 African countries were included. The majority of patients were young males (aged 20–35), and RTAs, especially motorcycle crashes, were the dominant mechanism of injury. Severe TBI (GCS ≤8) was common, and mortality rates ranged from 30% to 70% among this subgroup. Predictors of poor outcome included low GCS, hypotension, and delayed presentation. Access to neurosurgical intervention, CT imaging, and ICU care varied widely across centers, with several studies noting financial barriers as a major contributor to discharge against medical advice (DAMA). Only three studies reported long-term outcomes beyond hospital discharge. Risk-of-bias assessment found that most studies were at moderate risk of bias, with common limitations including single-centre hospital sampling, retrospective data collection in several cohorts, incomplete reporting of missing-data handling and sample-size justification, and limited follow-up or attrition for longer-term outcomes. Conclusion: RTA-related TBI in African urban centers is associated with high mortality and unfavorable functional outcomes, largely due to delayed access to care, limited imaging and ICU capacity, and socioeconomic constraints. Improved trauma systems, expanded neurocritical care services, and financial protection mechanisms are urgently needed to reduce preventable mortality and improve outcomes in this high-risk population.